Communicating is easier said than done

The first day of the RSNA meeting is always the best, perhaps because I have the most energy and enthusiasm. Ten years ago I didn't get tired until Thursday. Now I'm tired on Monday. I would like to blame it on changes in the meeting, but I have the same problem during a normal work week at home.

Still, Sunday was interesting. This year's theme is "Communication: Key to Improved Patient Care." RSNA president Dr. Peggy Fritzsche, in her opening remarks, focused on the need to improve communications with four groups: patients, colleagues, medical students, and the general public (essentially the whole world).

I pretty much agreed with everything she said. It is just so much easier to say it than to do it.

It is a rare week that I, as chair of our department, don't have to deal with a patient's complaint about something one of my partners said. Last week, I received a long letter from an offended mammography patient, forwarded from the hospital administration. During a breast ultrasound she had asked my partner why her doctor had written "mass" on her request, when she didn't feel a mass. My partner said he didn't know, perhaps it was to be certain her insurance company covered the exam. "How dare he accuse her of being a thief!" She wrote two pages detailing all the other similarly offensive things he said.

When a basically nice guy takes a few minutes to honestly answer a patient's questions, and she generates a two-page letter and a mountain of accompanying e-mails, "what we have here is a failure to communicate" (Cool Hand Luke was imitated pretty well on Sunday by Fritzsche). This is a no-win situation. We just sent her an apology. We always send an apology. And most of the time the hospital asks us to hold our bill. This is one of the keys to patient communications Fritzsche didn't cover. They are always right.

Communicating with referring physicians is another land mine. Fritzsche described a change we have seen and PACS has amplified: Referring physicians no longer routinely pass through radiology to review and discuss inpatients on rounds. As volumes have increased, we appreciate fewer interruptions, but I suspect a quantum leap down in the quality of care accompanied this change. For a year or two now, I have been trying to figure out the right way to reopen this casual line of communication that often made difficult cases much more understandable.

I have been talking to our administration about sponsoring a "radiology lunch," perhaps two or three times a week. My idea is to have a free sandwich buffet in a conference room where we go through any case on PACS that someone in attendance wishes to bring up. After hearing the talk yesterday, I feel even stronger that this is worth the risk of looking like a total Bozo.

Two communications tools Fritzsche didn't mention are RADPAC and the ACR. In general terms, she noted that medical decisions will be made with or without our input, so we need to speak up. My own feeling is the most critical place for that input is Congress. And with politicians, money talks. If you're not giving generously to RADPAC and supporting the ACR, you deserve to take it in the shorts from Medicare.

The welcoming remarks also included an a cappella serenade by the president of the Chicago Radiological Society. He is either very brave or very foolish, and it was fun.

The opening scientific session was "Trauma Imaging, Who, How, and Why." It was an interesting look at the reasonable, scientific approach to imaging in the ER, a very pertinent subject for anyone in radiology. Apparently, there are places where this approach is used, just not where I work. If you come into our ER with your head attached, you will get a head CT. If you have any symptoms below your neck, your chest and abdomen will get scanned too.

The folks who make algorithms based on "cost to society," "population risks," and "likelihood of disease" are not the ones who have to face the patient and/or their lawyer. The only certainty numbers acceptable are 100% and 0%. Otherwise, a CT or MR scan is probably is going to be done.

All in all, it was a good first day.